Ultrasound-guided fine-needle aspiration cytology of non-palpable supraclavicular lymph nodes in sarcoidosis.

PURPOSE: The aim of this prospective study was to determine the incidence of enlarged supraclavicular lymph nodes by US and the diagnostic yield of US-guided aspiration cytology in the diagnosis of sarcoidosis. METHODS: During a 54-month period, all consecutive patients with a clinical suspicion of sarcoidosis underwent supraclavicular US at the Kiljava Hospital, Finland. All patients with enlarged supraclavicular lymph nodes underwent US-guided fine-needle aspiration biopsy (FNAB) of the lymph node. RESULTS: Of a total of 250 patients, 27 (10.8%) had enlarged supraclavicular lymph nodes at US. All these were non-palpable at clinical examination. The cytological specimen was quantitatively sufficient in 25 of the 27 cases (93%). In 22 (88%) of these, the cytological diagnosis was granulomatous inflammation suggestive of sarcoidosis. Three aspirates yielded reactive hyperplasia and 2 specimens were insufficient. No complications occurred. The patients were followed for 2-42 months (mean 19 months), and the diagnosis of sarcoidosis was confirmed clinically in all cases. CONCLUSION: Supraclavicular US detects non-palpable enlarged lymph nodes in 1/10 of the patients with suspected sarcoidosis. In this subgroup of patients, US combined with aspiration cytology may give cytological evidence of granulomatous disease similar to sarcoidosis and more invasive diagnostic methods can be avoided.

Effect of intrauterine contraceptive devices on cytokine messenger ribonucleic acid expression in the human endometrium.

OBJECTIVE: To compare cytokine messenger RNA (mRNA) expression in the endometrium exposed to an intrauterine contraceptive device (IUD) and in normal cycling endometrium. DESIGN: Quantitative reverse-transcribed polymerase chain reaction was used to assess interleukin (IL) 1 beta, IL-6, tumor necrosis factor alpha (TNF-alpha), and colony-stimulating factor 1 (CSF-1) mRNA expression in endometrial tissue samples obtained by curettage or at hysterectomy from 11 women using a copper-releasing IUD, 10 women having a levonorgestrel-releasing IUD, and 13 fertile women during different phases of the menstrual cycle. RESULTS: The mRNAs encoding the studied cytokines were detected in all endometrial samples. The mean IL-1 beta, IL-6, and TNF-alpha mRNA levels were higher in the late secretory menstrual phase compared with the proliferative early secretory phase of the menstrual cycle both in endometria exposed to the copper IUD and in the control samples. The IL-1 beta and TNF-alpha mRNA levels were significantly higher in endometria exposed to the copper IUD compared with the control endometria in the late secretory menstrual phase, whereas no difference was found in the expression of these cytokine mRNAs during the proliferative early secretory phase. In contrast, the mean IL-6 mRNA level was higher in the copper IUD-exposed endometria than in the control endometria in the proliferative early secretory but not in the late secretory menstrual phase. In the levonorgestrel IUD-exposed endometria, the mean levels of IL-1 beta, TNF-alpha, and CSF-1 mRNA were similar to those in normal endometrium in the late secretory menstrual phase. The mean IL-6 mRNA level in levonorgestrel IUD-exposed endometria was lower than that in late secretory menstrual phase of controls but, because of a great individual variation in the control samples, the difference did not reach significance. No significant cyclic change nor any difference in relative CSF-1 mRNA levels between the three study groups was detected. CONCLUSIONS: These data provide the first evidence that the use of IUDs is associated with alterations in endometrial cytokine expression and that the alterations differ depending on the cytokine and the type of IUD. We speculate that cytokines are involved in intrauterine contraceptive effects of IUDs.

Diagnosis of diffuse lung disease by cutting needle biopsy.

The results of 15 consecutive automated cutting needle (1.2 mm, n = 14; 2.0 mm, n = 1) biopsies of diffuse lung manifestations are presented. Sufficient material for histologic analysis was obtained in 13 of 15 specimens (87%) and a specific diagnosis was obtained in 11 of 14 patients (79%). The tissue specimen confirmed the clinically probable lung disease in 6 patients, gave a new, unsuspected, diagnosis in 2, and resolved a differential diagnostic problem in 3 patients. One pneumothorax after a 2.0-mm needle biopsy necessitated catheter drainage. We conclude that percutaneous lung biopsy with the automated biopsy device mounted with a 1.2-mm needle yields a histologic diagnosis with high accuracy in interstitial and alveolar lung changes, reducing the need for more invasive methods such as open lung biopsy.

Melanoma of palms, soles, and nail-beds.

The clinical and histological characteristics of palmar, plantar, and subungual melanomas treated in the division of plastic surgery of Helsinki University Hospital between 1970 and 1984 were analysed. The peak incidence was during the seventh decade of life, and the mean delay between the onset of symptoms and the diagnosis was one year. The delay was as much the fault of the physician as of the patient. The observed and relative five-year-survival rates for all 31 patients were 60% and 67%, and the 10-year-survival rates 39% and 49%, respectively. There were 15 cases of the acral lentiginous subtype, and the observed and relative five-year-survival rates were 65% and 71%, and the 10-year-survival rates 48% and 64%, respectively. For the nodular melanomas (n = 11) the survival rates were 53% and 60%, and 39% and 53%, respectively. For the three superficial spreading melanomas they were 50% and 52%, and 25% and 28%, respectively. Microstaging criteria (Breslow and Clark) were both good prognostic indicators. The series was too small for multivariate analysis.

Bone formation in experimental myositis ossificans. Light and electron microscopy study.

The development of ectopic ossification in experimental myositis ossificans of the rabbit thigh was studied. The right hind limb of 25 rabbits was immobilized with the knee in extension. Once a day the limb was passively mobilized for 2-3 minutes. The animals were killed 3, 5, 7, 14, 21, 28 and 35 days after the beginning of the experiment. Specimens for light and electron microscopy were obtained from both hind limbs. Extensive necrosis and fibrosis were observed in the right vastus intermedius muscle during the first week. Proliferation of chondrocytes and osteoblasts with newly formed woven bone and cartilage formation were found in the periosteum within 7 and 14 days after the beginning of the experiment. Intensive enchondral ossification and hard calcified tissue were observed later. It was evident that bone formation in this experimental model started in the periosteum after necrosis of the adjacent skeletal muscle. Therefore the temporal and spatial relationship of traumatic changes in the periosteum and muscle seems important for the development of myositis ossificans.